Release 5

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

11.9 Resource ImmunizationRecommendation - Content

Public Health and Emergency Response icon

Work Group

Maturity Level: 1

Trial Use

Security Category: Patient

Compartments: Patient

A patient's point-in-time set of recommendations (i.e. forecasting) according to a published schedule with optional supporting justification.

11.9.1 Scope and Usage

The ImmunizationRecommendation resource is intended to cover communication of a specified patient's immunization recommendations and status across all healthcare disciplines in all care settings and all regions. The set of customized (for the patient) recommendations is based on the comparison of the patient's immunization history with a set of published recommendations (protocols).

Additionally, the ImmunizationRecommendation resource is expected to cover key concepts related to the querying of a patient's immunization recommendations and status. This resource - through consultation with the Public Health work group - is believed to meet key use cases and information requirements as defined in the existing HL7 v3 icon POIZ domain and Immunization Domain Analysis Model.

11.9.2 Boundaries and Relationships

This resource references the following resources:

Patient
Organization
Immunization
ImmunizationEvaluation

11.9.3 References to this Resource

Structure

Name	Flags	Card.	Type	Description & Constraints
ImmunizationRecommendation	TU		DomainResource	Guidance or advice relating to an immunization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Business identifier
patient	Σ	1..1	Reference(Patient)	Who this profile is for
date	Σ	1..1	dateTime	Date recommendation(s) created
authority		0..1	Reference(Organization)	Who is responsible for protocol
recommendation	Σ C	1..*	BackboneElement	Vaccine administration recommendations + Rule: One of vaccineCode or targetDisease SHALL be present
vaccineCode	Σ C	0..*	CodeableConcept	Vaccine or vaccine group recommendation applies to Binding: Vaccine Administered Value Set (Example)
targetDisease	Σ C	0..*	CodeableConcept	Disease to be immunized against Binding: Immunization Target Disease Codes (Example)
contraindicatedVaccineCode	Σ	0..*	CodeableConcept	Vaccine which is contraindicated to fulfill the recommendation Binding: Vaccine Administered Value Set (Example)
forecastStatus	?!Σ	1..1	CodeableConcept	Vaccine recommendation status Binding: Immunization Recommendation Status Codes (Example)
forecastReason	Σ	0..*	CodeableConcept	Vaccine administration status reason Binding: Immunization Recommendation Reason Codes (Example)
dateCriterion		0..*	BackboneElement	Dates governing proposed immunization
code		1..1	CodeableConcept	Type of date Binding: Immunization Recommendation Date Criterion Codes (Example)
value		1..1	dateTime	Recommended date
description		0..1	markdown	Protocol details
series		0..1	string	Name of vaccination series
doseNumber	Σ	0..1	string	Recommended dose number within series
seriesDoses		0..1	string	Recommended number of doses for immunity
supportingImmunization		0..*	Reference(Immunization \| ImmunizationEvaluation)	Past immunizations supporting recommendation
supportingPatientInformation		0..*	Reference(Any)	Patient observations supporting recommendation
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<ImmunizationRecommendation xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <patient><!-- 1..1 Reference(Patient) Who this profile is for --></patient>
 <date value="[dateTime]"/><!-- 1..1 Date recommendation(s) created -->
 <authority><!-- 0..1 Reference(Organization) Who is responsible for protocol --></authority>
 <recommendation>  <!-- 1..* Vaccine administration recommendations -->
  <vaccineCode><!-- I 0..* CodeableConcept Vaccine  or vaccine group recommendation applies to --></vaccineCode>
  <targetDisease><!-- I 0..* CodeableConcept Disease to be immunized against --></targetDisease>
  <contraindicatedVaccineCode><!-- 0..* CodeableConcept Vaccine which is contraindicated to fulfill the recommendation --></contraindicatedVaccineCode>
  <forecastStatus><!-- 1..1 CodeableConcept Vaccine recommendation status --></forecastStatus>
  <forecastReason><!-- 0..* CodeableConcept Vaccine administration status reason --></forecastReason>
  <dateCriterion>  <!-- 0..* Dates governing proposed immunization -->
   <code><!-- 1..1 CodeableConcept Type of date --></code>
   <value value="[dateTime]"/><!-- 1..1 Recommended date -->
  </dateCriterion>
  <description value="[markdown]"/><!-- 0..1 Protocol details -->
  <series value="[string]"/><!-- 0..1 Name of vaccination series -->
  <doseNumber value="[string]"/><!-- 0..1 Recommended dose number within series -->
  <seriesDoses value="[string]"/><!-- 0..1 Recommended number of doses for immunity -->
  <supportingImmunization><!-- 0..* Reference(Immunization|ImmunizationEvaluation) Past immunizations supporting recommendation --></supportingImmunization>
  <supportingPatientInformation><!-- 0..* Reference(Any) Patient observations supporting recommendation --></supportingPatientInformation>
 </recommendation>
</ImmunizationRecommendation>

JSON Template

{
  "resourceType" : "ImmunizationRecommendation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "patient" : { Reference(Patient) }, // R!  Who this profile is for
  "date" : "<dateTime>", // R!  Date recommendation(s) created
  "authority" : { Reference(Organization) }, // Who is responsible for protocol
  "recommendation" : [{ // R!  Vaccine administration recommendations
    "vaccineCode" : [{ CodeableConcept }], // I Vaccine  or vaccine group recommendation applies to
    "targetDisease" : [{ CodeableConcept }], // I Disease to be immunized against
    "contraindicatedVaccineCode" : [{ CodeableConcept }], // Vaccine which is contraindicated to fulfill the recommendation
    "forecastStatus" : { CodeableConcept }, // R!  Vaccine recommendation status
    "forecastReason" : [{ CodeableConcept }], // Vaccine administration status reason
    "dateCriterion" : [{ // Dates governing proposed immunization
      "code" : { CodeableConcept }, // R!  Type of date
      "value" : "<dateTime>" // R!  Recommended date
    }],
    "description" : "<markdown>", // Protocol details
    "series" : "<string>", // Name of vaccination series
    "doseNumber" : "<string>", // Recommended dose number within series
    "seriesDoses" : "<string>", // Recommended number of doses for immunity
    "supportingImmunization" : [{ Reference(Immunization|ImmunizationEvaluation) }], // Past immunizations supporting recommendation
    "supportingPatientInformation" : [{ Reference(Any) }] // Patient observations supporting recommendation
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:ImmunizationRecommendation;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business identifier
  fhir:patient [ Reference(Patient) ] ; # 1..1 Who this profile is for
  fhir:date [ dateTime ] ; # 1..1 Date recommendation(s) created
  fhir:authority [ Reference(Organization) ] ; # 0..1 Who is responsible for protocol
  fhir:recommendation ( [ # 1..* Vaccine administration recommendations
    fhir:vaccineCode  ( [ CodeableConcept ] ... ) ; # 0..* I Vaccine  or vaccine group recommendation applies to
    fhir:targetDisease  ( [ CodeableConcept ] ... ) ; # 0..* I Disease to be immunized against
    fhir:contraindicatedVaccineCode  ( [ CodeableConcept ] ... ) ; # 0..* Vaccine which is contraindicated to fulfill the recommendation
    fhir:forecastStatus [ CodeableConcept ] ; # 1..1 Vaccine recommendation status
    fhir:forecastReason  ( [ CodeableConcept ] ... ) ; # 0..* Vaccine administration status reason
    fhir:dateCriterion ( [ # 0..* Dates governing proposed immunization
      fhir:code [ CodeableConcept ] ; # 1..1 Type of date
      fhir:value [ dateTime ] ; # 1..1 Recommended date
    ] ... ) ;
    fhir:description [ markdown ] ; # 0..1 Protocol details
    fhir:series [ string ] ; # 0..1 Name of vaccination series
    fhir:doseNumber [ string ] ; # 0..1 Recommended dose number within series
    fhir:seriesDoses [ string ] ; # 0..1 Recommended number of doses for immunity
    fhir:supportingImmunization  ( [ Reference(Immunization|ImmunizationEvaluation) ] ... ) ; # 0..* Past immunizations supporting recommendation
    fhir:supportingPatientInformation  ( [ Reference(Any) ] ... ) ; # 0..* Patient observations supporting recommendation
  ] ... ) ;
]

Changes from both R4 and R4B

ImmunizationRecommendation

ImmunizationRecommendation.recommendation.targetDisease

Max Cardinality changed from 1 to *

ImmunizationRecommendation.recommendation.description

Type changed from string to markdown

ImmunizationRecommendation.recommendation.doseNumber

Renamed from doseNumber[x] to doseNumber
Remove Type positiveInt

ImmunizationRecommendation.recommendation.seriesDoses

Renamed from seriesDoses[x] to seriesDoses
Remove Type positiveInt

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Structure

Name	Flags	Card.	Type	Description & Constraints
ImmunizationRecommendation	TU		DomainResource	Guidance or advice relating to an immunization Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
identifier	Σ	0..*	Identifier	Business identifier
patient	Σ	1..1	Reference(Patient)	Who this profile is for
date	Σ	1..1	dateTime	Date recommendation(s) created
authority		0..1	Reference(Organization)	Who is responsible for protocol
recommendation	Σ C	1..*	BackboneElement	Vaccine administration recommendations + Rule: One of vaccineCode or targetDisease SHALL be present
vaccineCode	Σ C	0..*	CodeableConcept	Vaccine or vaccine group recommendation applies to Binding: Vaccine Administered Value Set (Example)
targetDisease	Σ C	0..*	CodeableConcept	Disease to be immunized against Binding: Immunization Target Disease Codes (Example)
contraindicatedVaccineCode	Σ	0..*	CodeableConcept	Vaccine which is contraindicated to fulfill the recommendation Binding: Vaccine Administered Value Set (Example)
forecastStatus	?!Σ	1..1	CodeableConcept	Vaccine recommendation status Binding: Immunization Recommendation Status Codes (Example)
forecastReason	Σ	0..*	CodeableConcept	Vaccine administration status reason Binding: Immunization Recommendation Reason Codes (Example)
dateCriterion		0..*	BackboneElement	Dates governing proposed immunization
code		1..1	CodeableConcept	Type of date Binding: Immunization Recommendation Date Criterion Codes (Example)
value		1..1	dateTime	Recommended date
description		0..1	markdown	Protocol details
series		0..1	string	Name of vaccination series
doseNumber	Σ	0..1	string	Recommended dose number within series
seriesDoses		0..1	string	Recommended number of doses for immunity
supportingImmunization		0..*	Reference(Immunization \| ImmunizationEvaluation)	Past immunizations supporting recommendation
supportingPatientInformation		0..*	Reference(Any)	Patient observations supporting recommendation
Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

XML Template

<ImmunizationRecommendation xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <patient><!-- 1..1 Reference(Patient) Who this profile is for --></patient>
 <date value="[dateTime]"/><!-- 1..1 Date recommendation(s) created -->
 <authority><!-- 0..1 Reference(Organization) Who is responsible for protocol --></authority>
 <recommendation>  <!-- 1..* Vaccine administration recommendations -->
  <vaccineCode><!-- I 0..* CodeableConcept Vaccine  or vaccine group recommendation applies to --></vaccineCode>
  <targetDisease><!-- I 0..* CodeableConcept Disease to be immunized against --></targetDisease>
  <contraindicatedVaccineCode><!-- 0..* CodeableConcept Vaccine which is contraindicated to fulfill the recommendation --></contraindicatedVaccineCode>
  <forecastStatus><!-- 1..1 CodeableConcept Vaccine recommendation status --></forecastStatus>
  <forecastReason><!-- 0..* CodeableConcept Vaccine administration status reason --></forecastReason>
  <dateCriterion>  <!-- 0..* Dates governing proposed immunization -->
   <code><!-- 1..1 CodeableConcept Type of date --></code>
   <value value="[dateTime]"/><!-- 1..1 Recommended date -->
  </dateCriterion>
  <description value="[markdown]"/><!-- 0..1 Protocol details -->
  <series value="[string]"/><!-- 0..1 Name of vaccination series -->
  <doseNumber value="[string]"/><!-- 0..1 Recommended dose number within series -->
  <seriesDoses value="[string]"/><!-- 0..1 Recommended number of doses for immunity -->
  <supportingImmunization><!-- 0..* Reference(Immunization|ImmunizationEvaluation) Past immunizations supporting recommendation --></supportingImmunization>
  <supportingPatientInformation><!-- 0..* Reference(Any) Patient observations supporting recommendation --></supportingPatientInformation>
 </recommendation>
</ImmunizationRecommendation>

JSON Template

{
  "resourceType" : "ImmunizationRecommendation",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business identifier
  "patient" : { Reference(Patient) }, // R!  Who this profile is for
  "date" : "<dateTime>", // R!  Date recommendation(s) created
  "authority" : { Reference(Organization) }, // Who is responsible for protocol
  "recommendation" : [{ // R!  Vaccine administration recommendations
    "vaccineCode" : [{ CodeableConcept }], // I Vaccine  or vaccine group recommendation applies to
    "targetDisease" : [{ CodeableConcept }], // I Disease to be immunized against
    "contraindicatedVaccineCode" : [{ CodeableConcept }], // Vaccine which is contraindicated to fulfill the recommendation
    "forecastStatus" : { CodeableConcept }, // R!  Vaccine recommendation status
    "forecastReason" : [{ CodeableConcept }], // Vaccine administration status reason
    "dateCriterion" : [{ // Dates governing proposed immunization
      "code" : { CodeableConcept }, // R!  Type of date
      "value" : "<dateTime>" // R!  Recommended date
    }],
    "description" : "<markdown>", // Protocol details
    "series" : "<string>", // Name of vaccination series
    "doseNumber" : "<string>", // Recommended dose number within series
    "seriesDoses" : "<string>", // Recommended number of doses for immunity
    "supportingImmunization" : [{ Reference(Immunization|ImmunizationEvaluation) }], // Past immunizations supporting recommendation
    "supportingPatientInformation" : [{ Reference(Any) }] // Patient observations supporting recommendation
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .


[ a fhir:ImmunizationRecommendation;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Business identifier
  fhir:patient [ Reference(Patient) ] ; # 1..1 Who this profile is for
  fhir:date [ dateTime ] ; # 1..1 Date recommendation(s) created
  fhir:authority [ Reference(Organization) ] ; # 0..1 Who is responsible for protocol
  fhir:recommendation ( [ # 1..* Vaccine administration recommendations
    fhir:vaccineCode  ( [ CodeableConcept ] ... ) ; # 0..* I Vaccine  or vaccine group recommendation applies to
    fhir:targetDisease  ( [ CodeableConcept ] ... ) ; # 0..* I Disease to be immunized against
    fhir:contraindicatedVaccineCode  ( [ CodeableConcept ] ... ) ; # 0..* Vaccine which is contraindicated to fulfill the recommendation
    fhir:forecastStatus [ CodeableConcept ] ; # 1..1 Vaccine recommendation status
    fhir:forecastReason  ( [ CodeableConcept ] ... ) ; # 0..* Vaccine administration status reason
    fhir:dateCriterion ( [ # 0..* Dates governing proposed immunization
      fhir:code [ CodeableConcept ] ; # 1..1 Type of date
      fhir:value [ dateTime ] ; # 1..1 Recommended date
    ] ... ) ;
    fhir:description [ markdown ] ; # 0..1 Protocol details
    fhir:series [ string ] ; # 0..1 Name of vaccination series
    fhir:doseNumber [ string ] ; # 0..1 Recommended dose number within series
    fhir:seriesDoses [ string ] ; # 0..1 Recommended number of doses for immunity
    fhir:supportingImmunization  ( [ Reference(Immunization|ImmunizationEvaluation) ] ... ) ; # 0..* Past immunizations supporting recommendation
    fhir:supportingPatientInformation  ( [ Reference(Any) ] ... ) ; # 0..* Patient observations supporting recommendation
  ] ... ) ;
]

Changes from both R4 and R4B

ImmunizationRecommendation

ImmunizationRecommendation.recommendation.targetDisease

Max Cardinality changed from 1 to *

ImmunizationRecommendation.recommendation.description

Type changed from string to markdown

ImmunizationRecommendation.recommendation.doseNumber

Renamed from doseNumber[x] to doseNumber
Remove Type positiveInt

ImmunizationRecommendation.recommendation.seriesDoses

Renamed from seriesDoses[x] to seriesDoses
Remove Type positiveInt

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

See R4 <--> R5 Conversion Maps (status = See Conversions Summary.)

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

11.9.4.1 Terminology Bindings

Path	ValueSet	Type	Documentation
ImmunizationRecommendation.recommendation.vaccineCode	VaccineAdministeredValueSet	Example	This identifies the vaccine substance administered - CVX codes.
ImmunizationRecommendation.recommendation.targetDisease	ImmunizationTargetDiseaseCodes	Example	The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the disease that the dose is being administered against. This value set is provided as a suggestive example and includes SNOMED CT concepts from the 64572001 (Disease) hierarchy.
ImmunizationRecommendation.recommendation.contraindicatedVaccineCode	VaccineAdministeredValueSet	Example	This identifies the vaccine substance administered - CVX codes.
ImmunizationRecommendation.recommendation.forecastStatus	ImmunizationRecommendationStatusCodes	Example	The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the status of the patient towards perceived immunity against a vaccine preventable disease. This value set is provided as a suggestive example.
ImmunizationRecommendation.recommendation.forecastReason	ImmunizationRecommendationReasonCodes	Example	The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reasons why a given recommendation status is assigned. This value set is provided as a suggestive example and includes SNOMED CT concepts.
ImmunizationRecommendation.recommendation.dateCriterion.code	ImmunizationRecommendationDateCriterionCodes	Example	The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support the definition of dates relevant to recommendations for future doses of vaccines. This value set is provided as a suggestive example.

Path

ValueSet

Type

Documentation

ImmunizationRecommendation.recommendation.vaccineCode

VaccineAdministeredValueSet

Example

This identifies the vaccine substance administered - CVX codes.

ImmunizationRecommendation.recommendation.targetDisease

ImmunizationTargetDiseaseCodes

Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the disease that the dose is being administered against. This value set is provided as a suggestive example and includes SNOMED CT concepts from the 64572001 (Disease) hierarchy.

ImmunizationRecommendation.recommendation.contraindicatedVaccineCode

VaccineAdministeredValueSet

Example

This identifies the vaccine substance administered - CVX codes.

ImmunizationRecommendation.recommendation.forecastStatus

ImmunizationRecommendationStatusCodes

Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the status of the patient towards perceived immunity against a vaccine preventable disease. This value set is provided as a suggestive example.

ImmunizationRecommendation.recommendation.forecastReason

ImmunizationRecommendationReasonCodes

Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reasons why a given recommendation status is assigned. This value set is provided as a suggestive example and includes SNOMED CT concepts.

ImmunizationRecommendation.recommendation.dateCriterion.code

ImmunizationRecommendationDateCriterionCodes

Example

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support the definition of dates relevant to recommendations for future doses of vaccines. This value set is provided as a suggestive example.

11.9.4.2 Constraints

UniqueKey

Level

Location

Description

Expression

imr-1

Rule

ImmunizationRecommendation.recommendation

One of vaccineCode or targetDisease SHALL be present

vaccineCode.exists() or targetDisease.exists()

11.9.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name	Type	Description	Expression	In Common
date	date	Date recommendation(s) created	ImmunizationRecommendation.date	27 Resources
identifier	token	Business identifier	ImmunizationRecommendation.identifier	65 Resources
information	reference	Patient observations supporting recommendation	ImmunizationRecommendation.recommendation.supportingPatientInformation (Any)
patient	reference	Who this profile is for	ImmunizationRecommendation.patient (Patient)	66 Resources
status	token	Vaccine recommendation status	ImmunizationRecommendation.recommendation.forecastStatus
support	reference	Past immunizations supporting recommendation	ImmunizationRecommendation.recommendation.supportingImmunization (Immunization, ImmunizationEvaluation)
target-disease	token	Disease to be immunized against	ImmunizationRecommendation.recommendation.targetDisease
vaccine-type	token	Vaccine or vaccine group recommendation applies to	ImmunizationRecommendation.recommendation.vaccineCode